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Quality Improvement Resources for Surgical Oncology

Learn, discuss and provide feedback on quality issues in cancer care with these educational tools for Ontario physicians. These resources have been used within the provincial strategy and may be useful to hospital or regional groups.

As part of a multifaceted knowledge translation strategy, these educational tools help Ontario hospitals implement sentinel lymph node biopsy for breast cancer patients.

Breast Sentinal Lymph Node Biopsy Perspective Series

Cancer Care Ontario offered forums for surgeons and pathologists to gain a broader understanding of SLNB. PowerPoint presentations with audio of different SLNB clinical perspectives are provided here as part of the Breast SLNB Perspective Series.

SLNB and the Surgeon Dr. Ralph George, CIBC Breast Centre, St. Michael’s Hospital

SLNB and the Pathologist Dr. Sandip SenGupta, Kingston General Hospital

SLNB and the Medical Oncologist Dr. Christine Brezden-Masley, Keenan Research Centre, St. Michael’s Hospital

Educational Tools

Pathology assessment tips for SLNB

The 2010 Pathology Update included a Breast: SLNB Pathology Refresher Course, hosted by Cancer Care Ontario, as a means to disseminate the most current information surrounding SLN pathology. A presentation with audio covering the technical aspects of SLN Pathology is available here:

Technical SLNB Tips for Pathologist: Pathologic Assessment of the SLN Dr. Pratibha Iyengar, Credit Valley Hospital

Guidance to implementing breast SLNB within a hospital

Information to consider to improve the availability of SLNB at hospitals and address common barriers to SLNB, including nuclear medicine.

Information Package (toolkit)

Breast Cancer: SLNB Clinical Scenarios

Five SLNB clinical scenarios were presented at Cancer Care Ontario’s Breast: SLNB Surgery Refresher Course as part of the 2010 Update in Surgical Oncology. The surgical management of these cases was discussed by an expert panel.

SLNB Scenario Group Discussion

Axillary Lymph Node Dissection (video)

Presented by the Department of Surgical Oncology, Perioperative Interactive Education at Princess Margaret Hospital, the purpose of the video is to provide an overview of the anatomical and surgical aspects of the axillary lymph node dissection (ALND) procedure. This video was designed to augment surgical residents' understanding of the anatomy of the axilla, and the surgical approaches to isolate and excise the axillary fat and lymph nodes.

These resources may help colorectal cancer regional champions or those who are involved in the care of colorectal cancer patients.

Standardized Tools

Surgeons, radiologists and pathologists can use these valid and reliable report templates and accompanying educational materials to improve consistency of imaging and specimen reporting across the province.

Radiology: Synoptic MRI Report for Rectal Cancer

Download the synoptic MRI report template and additional educational materials to implement at institutions. The template is for oncology specialists to assist with neoadjuvant chemo radiation decisions, and preoperative planning for patients with adenocarcinoma of the rectum (who are being considered for total mesorectal excision with or without abdominal perineal resection).

MRI Rectal Staging Template

MRI Rectal Staging Template User’s Guide

MRI Rectal Template Revisions Summary

The template is also a useful communication tool to inform treatment and prognostic discussions at multidisciplinary cancer conferences. Accompanying support material provides the description of terms, evidence basis and limitations.

2011 Radiology Rectal Cancer Webinar Presentation by Dr. Gina Brown (1hr 54 min)

  • Introduction (0.00 – 05:00)
  • Case Review #1 (05:01 – 27.20)
  • Case Review #2 (27:30 – 48:30)
  • Case Review #3 (48:35 – 01:01:35)
  • Case Review #4 (1:01:49 – 1:18:16)
  • Case Review #5 (1:18:20 – 1:25:28)
  • Q&A Discussion (1:25:00 – 1:51:53)

Pathology: Colorectal Cancer Gross Examination Standard Operating Procedure

Download the Colorectal Cancer (CRC) Gross Examination Standard Operating Procedure template and additional educational materials for the Quirke pathology method to implement at institutions.

Colorectal Cancer Gross Examination: Standard Operating Procedure Template

Rectal Cancer Grossing Guideline

Colorectal Cancer Surgical Pathology Requisition Form

2011 Webinar Presentation on Issues in Processing Colon and Rectal Cancers by Dr. Phil Quirke (2hr 29min)

  • Introduction (0.00 – 04:53)
  • Presentation on dissection and reporting (04:55 – 58.50)
  • Demonstration of specimen processing (58:36 – 1:44:44)
  • Q&A Discussion (1:44:45 – 2:00:29)

Educational Tools

Physicians can use these tools to improve their knowledge of colorectal cancer management.

Educational presentations on the Margin and Lymph Node Guideline

Download these presentations to use at regional education rounds or meetings.




These resources may help prostate cancer regional champions or those who are involved in the care of prostate cancer patients.

Education Tools

Physicians can use these tools to improve their knowledge of prostate cancer management.

Education tools for patients considering active surveillance

Prostate Cancer – Active Surveillance – A Guide for Patients

Education presentations on the Optimization of Radical Prostatectomy Guideline

Download these resources for use at regional education rounds or meetings.



A key knowledge translation strategy used within the Surgical Oncology Program are communities of practice or COPs. A community of practice consists of a group of people who share a common concern, set of problems or passion about a topic, that expand their knowledge and expertise in their area of interest through ongoing interaction with each other.

How to Create a Community of Practice

Establishing a community of practice involves leadership, determination and drive to achieve common goals and objectives. When establishing a COP, the purpose behind it needs to be kept in mind.

  • A leader(s) facilitates the group to reach consensus on the focus of the COP, how it will operate and who should participate.
  • The focus may be colorectal cancer, surgical technology or any other topic of interest.
  • Participation in the COP is typically voluntary.
  • Participants include those interested in the subject and those who will contribute to completing the priorities.
  • The COP meets regularly to discuss priority topics.

The Role of a Community of Practice Member

Specific roles and responsibilities of a member may include:

  • participation in the development of provincial and/or regional priorities and goals for the COP
  • sharing of best practices and barriers to quality improvement with other COP members
  • developing and maintaining working relationships with relevant stakeholders
  • promoting or leading the implementation of quality improvement initiatives
  • participation in regional and/or provincial teleconferences/web conferences/in-person meetings

It is important to note that the expectations of members should be adapted to meet the needs of each specific COP.

How the Surgical Oncology Program Supports Community Practices

The Surgical Oncology Program uses COPs composed of leaders from each region to move quality initiatives forward. Provincewide communities of practice have been established for several disease sites, with the purpose of identifying gaps in cancer care and developing quality improvement initiatives to address these gaps.

Regional surgical oncology leads and regional pathology leads nominated physician leaders (champions) such that each region (14) has a surgery, and a pathology, champion which are brought together to discuss various quality topics related to their respective expertise – prostate or colorectal cancer.

COP members (champions) participate in provincial web-conferences, in-person meetings and opinion leader site visits, to work towards achieving their identified goals and objectives.

Members are also expected to develop COPs within their own regions for their respective disease site that encompasses multiple physician disciplines and hospitals from within the region.

Key Elements for Engaging Community of Practice Members

The key elements for engaging members include:

  • Leadership: A leader or leaders who actively work to engage a larger community and guide members.
  • Consensus Building and Seeking Input: Experience has shown that engaging all of the appropriate disciplines and relevant stakeholders early in the process will aid in the success of implementing the end product.
  • Communication: Keeping open and regular communication with members (e.g., meetings, emails and newsletters) may assist in building the COP’s identity.
  • Self-Audit through Data Collection: When the COP is focused on a quality initiative, members have stated that auditing the initiative and providing individual feedback to members in a productive and non-threatening manner is very effective at improving quality.

The Surgical Oncology Program has successfully employed several strategies at a provincial level to engage members of the colorectal cancer and prostate cancer community of practices:

  • Provincial Workshops: In-person workshops and web-conferences provide an opportunity for multiple disciplines from across the province to come together and discuss quality improvement initiatives, identify gaps in care and determine goals for the COP.
  • List Serv Online Discussion Forum: List Servs provide a multidisciplinary online discussion platform for physicians/COP members to improve their knowledge and management of cancer.
  • Newsletters: Newsletters keep COP members informed of quality improvement initiatives occurring in the province.
  • Data Distribution: Data is an important driver of quality improvement, and the development and reporting of quality indicators has proven to be a successful knowledge transfer strategy.
  • Educational Slide Decks: Presentations on quality initiatives can be used at regional educational rounds or meetings. Member engagement strategies may vary depending on the goals, structure and size of the COP.

Have Questions? Email Us

To enquire further about community of practices with the Surgical Oncology Program, or to share a unique solution or best practice from your region, please email